Provider Demographics
NPI:1598186876
Name:KRYNITZ, JOHNNY
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:KRYNITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:12300 FT. MCCLANE ROAD
Mailing Address - City:RADIUM SPRINGS
Mailing Address - State:NM
Mailing Address - Zip Code:88054-0385
Mailing Address - Country:US
Mailing Address - Phone:575-635-0559
Mailing Address - Fax:
Practice Address - Street 1:12300 FT. MCCLANE ROAD
Practice Address - Street 2:
Practice Address - City:RADIUM SPRINGS
Practice Address - State:NM
Practice Address - Zip Code:88054
Practice Address - Country:US
Practice Address - Phone:575-635-0559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator